Pneumatosis Cystoides Intestinalis after Chemotherapy for Hematological Malignancies: Report of 4 Cases.

Abstract

Pneumatosis cystoides intestinalis (PCI) is knownto be a relatively rare condition which is characterized by gas cysts in the gastrointestinal mucosa. Wetreated four cases of PCI accompanied by hematological malignancies during chemotherapy treatment. All cases suffered from abdominal discomfort. Abdominal X-ray films revealed gas cysts in the intestine. PCI was observed during leukocytopenic states, and three cases had septicemia. Etoposide was administered to three cases, and prednisolone to all cases. It is considered that PCI sometimes occurs in patients with hematological malignancies during a period of leukocytopenia, and may be caused by intestinal mucosal damagedue to myelosuppressive agents and immunosuppressionfrom prednisolone. (Internal Medicine 34: 212-215, 1995)

Pneumatosis cystoides intestinalis after fluorouracil chemotherapy for rectal cancer

“…To our knowledge, FU-related or FU-induced PCI has not been reported previously. This case will add to the reported series of patients with FU-induced small bowel toxicity [3,4] and chemotherapy-related PCI [5][6][7][8][9] .…”

“…Several chemotherapeutic agents have been reported to be associated with PCI, including cyclophosphamide, cytarabine, vincristine, doxorubicin, daunorubicin, etoposide, docetaxel, irinotecan and cisplatin [5][6][7][8][9] . Although fluorouracil-related PCI has not been previously described, the cytotoxic effect of chemotherapy on the epithelial bowel can also play a role in the pathogenesis of PCI [7] .…”

“…Although fluorouracil-related PCI has not been previously described, the cytotoxic effect of chemotherapy on the epithelial bowel can also play a role in the pathogenesis of PCI [7] . Because the intestinal mucosa is highly proliferative, mucosal damage occurs easily during chemotherapy [6] . Moreover, the chemotherapeutic agent might interfere with the mucosal integrity of the intestinal tract, resulting in extensive intramural air [8] .…”

“…Tamura et al [15] reported that PCI following chemotherapy might be due to depletion of submucosal lymphoid tissue or leukemic infiltrates, such as denuded Peyer's patches producing mucosal defects, thereby permitting entry of gas into the bowel wall. It was reported that chemotherapy-related PCI occurs due to immunosuppressive treatment for hematological malignancies [5,6] . Neutropenia is an important factor for the development of PCI [5][6][7][8][9] .…”

“…It was reported that chemotherapy-related PCI occurs due to immunosuppressive treatment for hematological malignancies [5,6] . Neutropenia is an important factor for the development of PCI [5][6][7][8][9] . However, the current patient did not suffer from neutropenia before or when PCI was diagnosed.…”